Careful planning, then — gapped!

Chris Churchill, The Advocate

Published 6:00 pm, Saturday, January 19, 2013

Photo: SKIP DICKSTEIN

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Dale Christopher, left, and his wife Karen speak to the Times Union Advocate about his health care payment problems at his home Thursday morning, Jan. 17, 2013, in Wilton, N.Y. (Skip Dickstein/Times Union)

Dale Christopher, left, and his wife Karen speak to the Times Union Advocate about his health care payment problems at his home Thursday morning, Jan. 17, 2013, in Wilton, N.Y. (Skip Dickstein/Times Union)

Photo: SKIP DICKSTEIN

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Dale Christopher speaks to the Times Union Advocate about his health care payment problems at his home Thursday morning, Jan. 17, 2013, in Wilton, N.Y. (Skip Dickstein/Times Union)

Dale Christopher speaks to the Times Union Advocate about his health care payment problems at his home Thursday morning, Jan. 17, 2013, in Wilton, N.Y. (Skip Dickstein/Times Union)

The couple from Wilton thought they had planned a smooth transition from private health insurance to Medicare. They thought they were completely covered when they most needed the help, when Dale Christopher was diagnosed with cancer and needed expensive treatment.

But there was a gap — a $10,248 lapse.

This story starts last spring, as Dale Christopher prepared to end his career as a math teacher at Saratoga Springs schools. Just months before his retirement, he discovered a lump — and was told he had an advanced cancer that was rare but treatable.

That's scary stuff, obviously. But the Christophers at least had the security of health-insurance coverage.

Dale Christopher became eligible for Medicare Part B in May. But his private insurance was scheduled to end with the month of June, and the family didn't want to pay Medicare premiums while also paying for the coverage he got through work.

So the Christophers scratched the initial start of Medicare and arranged to have it launch at the start of July.

Simple enough, right?

It should have been.

But nothing, it seems, is ever easy when it comes to our Byzantine and Kafkaesque health-insurance system.

Late in June, Christopher received his Medicare card — and was surprised to see that it said his coverage would start in August.

Uh, oh.

The Christophers tried to fix the error. But at the time, Dale and Karen Christopher had bigger things on their minds. They were fighting for Dale's health, a battle that included time at Saratoga Hospital and trips to a New York City cancer center.

See, that's the thing about health insurance: It usually puts the most stress on people when they're already sapped by a terrifying disease.

Months later, bills for Christopher's treatment in July began to arrive. Today, the $10,248 remains unpaid.

Now, with the benefit of hindsight, it's probably clear the Christophers should have played it safe and allowed Medicare to overlap with the private coverage. After all, they estimate that delaying the payment of their Medicare premiums only saved them about $200.

It really doesn't seem like the Christophers' fault. I mean, they thought they were arranging to have Medicare start in July and were never told it wouldn't.

So how are they to blame for the gap? And how is it fair that they're now stuck with whopping bills?

The Christophers have appealed to the Social Security Administration to have their Medicare retroactively applied to July. But when I met them last week, they hadn't heard when there'd be a ruling on their appeal.

From the government, the Christophers had received only silence — despite the hours they'd spent on the phone trying to resolve the problem.

Their creditors, however, weren't being so reticent. They were increasingly insisting that the Christophers, who have four children, including two in college, start paying back the $10,248.

On Thursday, I contacted the Social Security Administration, which went to work investigating the Christophers' situation. And on Friday morning, the family received a call from an apologetic employee of the agency who promised to expedite their appeal.

It isn't at clear, however, that Medicare will take responsibility for the bill.

See, it turns out that the Dale Christopher had enrolled in what Medicare calls its "initial enrollment period" before then trying to enroll in a "special enrollment period" that allows coverage to begin the month after a retiree leaves a job. But the rules of the initial enrollment period take precedent if you've already started the process and blahbedy blah blah blahbedy blah blah.

It's all too complex and confusing. And as I see it, the Christophers should have been told of the potential consequences when they moved to delay the start of Medicare.

The family's experience is a lesson for anyone with Medicare on their horizon — mind the gap, or bridge the gap, or maybe even shop at the Gap. Spare no effort to avoid a lapse during the transition to Medicare.

The good news is that Dale Christopher's doctors believe he is cancer free. That's worth celebrating, even as he and his wife worry over about the still looming cost of making him better.

"Why did they let us cancel," Karen Christopher asked, "if they knew we could get into trouble?"